Just the Facts, the Crown virus.

[doc henderson]

Sedge, do you mind if I ask?  Oklahoma City or Tulsa?

[doctorb]

Regarding the death rates being decreased, many factors may be at play.  Improved care of the disease is one, and the fact that the increase in documented infections seems to be occurring in younger people, who have more physiologic reserve to cope with the disease.  Our understanding of the time course of this disease is clearing.  It takes a while for an increase in new infections to be measurable.  At least 3 weeks and probably more like 4-6 weeks.   Awaiting spikes in numbers of infections after states opened, or after any event like a protest or a political rally, takes a while and it's usually a bit longer than we originally expected. The delay is probably because of the time necessary for the virus to incubate in the person initially exposed, combined with the time it takes that person to infect others.

Death rates are lagging indicators, rising even later.  I wouldn't expect any measure of the death rates to change for 6-8 weeks.  With the rates of virus spread we are now witnessing in parts of the country, unfortunately, a rise in the death rates is almost assured.  We will see.

[doc henderson]

I agree.  the rural areas did such a good job following the rules, that the big cities could not.  so now we are most vulnerable for a wave to hit if everyone, for the most part, has not had the disease.  All the fact from fiction will take years to sort out.  Our country has done a good job of pulling together.  we t least now can test anyone that we want to.

[SwampDonkey]

End of the week, the Atlantic provinces intend to open borders between them. Not with Quebec or Maine, yet. New Brunswick, Nova Scotia, Prince Edward Island, and Newfoundland and Labrador are in that 'bubble'.

[Claybraker]

I agree.  the rural areas did such a good job following the rules, that the big cities could not.  so now we are most vulnerable for a wave to hit if everyone, for the most part, has not had the disease.  All the fact from fiction will take years to sort out.  Our country has done a good job of pulling together.  we t least now can test anyone that we want to.

My neighbor had to get tested (contact with an asymptomatic family member that tested positive).  It was a 6 hour wait in a drive through. Seems to me that needs work, but it's a local problem. What little I know (which isn't much) other than all the fact from fiction will take years to sort out. Currently BMP is implementing test and trace based on the success of other countries at least to this point.  I've been keeping an eye on https://testandtrace.com/state-data/  It's color coded easy to comprehend for us non medical types.

[Sedgehammer]

Sedge, do you mind if I ask?  Oklahoma City or Tulsa?

City
My daughter also mentioned that the fear factor in/at the hospital is greatly diminished. She said she's thinks it's from knowing what to do when now vs not knowing anything before. She said plasma is the go to treatment currently. They also promoted her to NICU. Starts next month. She just got her license in January.
She also said it had wiped out an entire hispanic family. Started with the mom, then spread.
I did mention before my wife was exposed from a patient she saw. Had the antibody test. Came back negative.
There also seems to be 2 main variants. D and G. G is many times more infectious, but not any more severe. D is what was spreading this spring.  G is the one spreading now. This is also why it may be affecting certain subsets now.

[doc henderson]

the antivirals and the antibodies are at the top of the list.  but still too early to know.  not much to loose at this point.  early in the disease everything works better, later in the course not as much works.  good to know.  so early on everything was reserved for the most ill, and did not show promise,  but early on they do help.

[alan gage]

the antivirals and the antibodies are at the top of the list.  but still too early to know.  not much to loose at this point.  early in the disease everything works better, later in the course not as much works.  good to know.  so early on everything was reserved for the most ill, and did not show promise,  but early on they do help.

When you say "early in the disease everything works better" and "early on they do help" do you mean on an individual basis (when a person first gets sick) or in a broad sense (just after a new virus appears in the world)?
Alan

[Ianab]

It makes sense that if you can treat a patient early in the disease, maybe before they really show symptoms, and slow the growth of the virus, that should give the body more time to fight it off, before serious damage is done. Once someones lungs have been turned to sludge, it's very hard to recover from that. 

Then it doesn't need to be a "magic" cure, just a useful treatment, and you could greatly reduce the fatality rate (and the lasting organ damage that seems to be affecting some survivors) 

But to do that you need the contact tracing and testing, which tends to get overwhelmed by a large outbreak. 

NZ borders are still closed to everyone except returning residents and "essential business" travel, and all of those have to do 2 weeks isolation. There are now about 22 active cases, but so far all have been caught at the border, and don't get let out of isolation until they test clear. 2 were accidentally let lose early, but they don't seem to have infected anyone else. 

We have postponed our trip to the Cook Islands that we had planned for late August, and will go to the South Island. Even if travel to the Cooks is open by then, there is a risk it could be disrupted again. or we end up in 2 week quarantine. Here in NZ everything is basically open again with no restriction, and the tourist stuff discounting to attract locals because their usual overseas customers are missing. Silver lining for us as things wont be crowded.

[doc henderson]

so some meds are like a "sun screen" and can prevent a serious illness.  once you have fluid in you lungs and all the inflammation, it takes time to clear.  so if you can prevent this in the first place, folks do well.  so individual cases.  all blood donors are now tested, and if positive, will be notified to donate plasma for others, and it will theoretically help, but not much data yet.  anecdotally maybe helps late in the disease.  the anti-viral med will help reduce reproduction and spread.  it needs to be early, like sun screen, to prevent the inflammation.  just like with asthma, after a few days of inflammation, the steroids help less, than at the beginning before all the cytokines and other inflammatory chemical are released. 

[Larry]

I live in Washington county Arkansas.  Covid testing is running 30% positive which is the highest in the state.

Common knowledge of why we test so high.  We have poultry processing plants with crowded working conditions.  The work is minimum wage and often the workers live in group housing which hastens the spread.  I'm not sure what can be done in the plants.  They are "essential" and can't be shut down the way I understand it.

I would expect with 30% positively, its going to be tough to bring the rate down until the entire population has been exposed.

I stay home a lot and mask up when going to the stores.  The city of Fayetteville is requiring masks in all stores.

[doc henderson]

Yes, other rural area would be less risky.  but in a sence, these meat plants and people who work there living with extended family in one house or apartment, are like a big city.  worse is many of the rapid test are not fda approved, have not been well studied, and may have high false negative rates.  so a pt. who has all the signs in terms of labs, x-ray, and symptoms, will be treated as positive, even if the testing is all negative.  so isolation and PPE for all.  so a neg. is not that helpful, + means you prob. have it.  so keeping to yourself, and taking precautions in public, and you should be ok.  the social distancing, at least kept the hospitals from being overwhelmed, although in areas where not many have been exposed, it could all break loose.  In some ways we will be better off when everyone has been exposed or immunized.  But that could mean the loss of loved ones in the process.  

[doc henderson]

Larry, it also depends on if most of the testing is done on highly suspect patients.  If everyone in the community was tested, then that is high.  If we were so selective in our testing, that only highly suspect cases are tested, then this is why it is high, and that is not the prevalence in the community.

[Larry]

There doing free drive up testing at our biggest hospital.  Several of the smaller hospitals are also doing the same.  Anybody that wants a test gets one, so I think a good sample of our general population.

A couple of CDC teams were sent to our area to figure out why and what to do but nothing from them yet.  A tough problem and they have my respect.

[doc henderson]

thanks Larry, we are all learning from the experience from across the country and world.  It may be a good cross section, but may be skewed to the people most concerned like the elderly (anyone older than me)  as an example.  or those with exposure/high risk.  stay healthy!

[doc henderson]

so all the people who do not want it, are staying home. and not only are negative, but are not getting tested!  like you!

[Don P]

Well, if 3 in 10 people are testing positive and they say the problem is 10x as bad as they've been finding I figure that's a 300% infection rate walking around just the other side of my mailbox. I'll continue to stay home!

[YellowHammer]

So is the standard treatment, as soon as it's confirmed as covid, to give anti inflammation drugs immediately?  Then sent back home, hopefully to recover?

Or treat on symptom onset, but before test confirmation?  Our current testing time here in Huntsville has grown to 5 days due to the increase in cases. 



  

[doc henderson]

we were down to a one day turnaround.  we have a faster test if needed, but has to be curried 30 minutes away.  that has been the issue with no studies to rely on.  the drugs we have all heard about were unproven, so approved for compassionate use (very sick), and in short supply for the most part since the demand is suddenly increased.  there is all kinds of info out about blood type and race ect.  it does not help unless it gives us info on new drugs or treatments.  we have an antiviral showing promise.  It is used in the hospital.  We can get, but must apply for the plasma (antibodies made by a previously infected pt.) and assume this will help with immunity to decrease the level of infection.  We wonder if the reason kids get it less, is due to all the other common cold corona viruses that kids get.  we are still not sure about the anti-inflammatory.  so we have been set up to fail if they all work early, but are less effective later, since this is new, and all unproven.  most drugs requested are used in the already sick! lots of vaccines being developed and tested.  Any info out now is premature and will need further study to really know.  just cause we are using it, does not mean it will work.  very hard to sort through all the "stuff" out there.  too early say standard treatment.  as you get sicker and or with co-morbid features, we throw everything at it.  Ventilation allows your body to rest while the lungs heal.  Proning (laying on stomach instead of back) has helped for folks on vents, as it does with other conditions requiring long term ventilation.

[Larry]

There doing free drive up testing at our biggest hospital.  Several of the smaller hospitals are also doing the same.  Anybody that wants a test gets one, so I think a good sample of our general population.

The policy was changed today.  To get a test now, one needs to be symptomatic or have positive exposure. 

The reason given was they are running low on testing supplies, not enough PPE for the testers, and not enough staff.  As reported by the local TV stations.

[Sedgehammer]

Nice to have moved manufacturing offshore ain't it. Life will be better they said.....

[alan gage]

Our local vet (only one in the county) had his whole office come down with Covid two weeks ago so they've been shut down. An intern came to ride with him for a couple weeks while he did large animal stuff and they believe that's where it came from as she was the first to test negative and after alerting them they all tested positive.

Anyway, he and his wife (don't know about the rest of the staff) soon came down sick. Talked to him on the phone yesterday and he still sounded a bit tough. Said he was getting better but still running a fever, and had been for nearly 2 weeks now. The wife got over it quite quickly he said.

He's in his early 60's, maybe late 50's, and appears to be the picture of health for someone his age. Slim, active, doesn't smoke, and isn't a drunk (as far as I know). Would have thought if anyone would sail through the illness he would have. Sounds like he'll be fine but it was a bit of a wake up call that something bad could happen to people I wouldn't expect it to.

Alan

[doc henderson]

health is great thing to have, but sometimes it is just good or bad luck it seems.  Hope he and his family and staff do well.

[YellowHammer]

So I'm confused about the testing.  If you think you get exposed to the virus today, and you get tested tomorrow, will the test result be accurate?  Or does the virus have to replicate for some number of days before the test can detect it or its byproducts? 

If so, should you you wait a few days after possible exposure to get tested?  Or get tested immediately upon notification of exposure?  

[Ianab]

If you think you get exposed to the virus today, and you get tested tomorrow, will the test result be accurate?

I don't think it works instantly, like you said, the virus has to start replicating and that takes time (days). When folks go through the 14 day isolation coming into NZ they get tested at day 3 and day 13, or if they start showing symptoms. I think symptoms generally show up 3 to 7 days later in most cases. 

Advice here was, if you think you were exposed, act like you have got it, until you know otherwise. If you go 14 days without symptoms, then you didn't catch it (or caught such a mild case you didn't notice). either way, you should then be clear.